Our long-term goal is to improve equity of access to quality health care, using telehealth systems as a means of incorporating small hospitals into a regionalized network system with provision of a comprehensive range of hospital based health services. Anesthesia services are attractive as a model for development of such telehealth system because: 1) there is a large group of non-physician providers of anestheisa care now in practice; 2) 70% of anesthetics in rural and inner-city hospitals are administered by nurse anesthetists, often without access to consultation with physician anesthesiologists, while anesthesiologists practice primarily in wealthier urban areas and large medical centers; 3) anesthesia care is technology-intensive and personnel-intensive, and therefore expensive; 4) anesthesia related morbidity and mortality constitute a serious problem to the public health, with preventable anesthesia deaths estimated at more than 10,000 annually in the United States. In this 3 year project we will 1) assess needs for anesthesiologist consultation by performing a survey endorsed by the Council on Nurse Anesthesia Practice, AANA, and 2) demonstrate a comprehensive telehealth anesthesia program using narrow-band telecommunication to bring consultation and computer-based monitoring from a large medical center to a small rural hospital. We will emphasize team building; practical use of new technology; evaluation of benefits to patients, and the health-care system. Dissemination of information obtained will be accomplished by a series of reports, workshops, and development of guidelines for implementing telehealth systems.